What Matters
At the core of the 4Ms framework is the principle of focusing on What Matters to each older adult. This element ensures that the individual's unique health priorities, goals, and care preferences guide all healthcare decisions. For a care plan to be truly effective, it must be aligned with what the person values most, whether it’s walking independently, maintaining a specific hobby, or spending time with family. This patient-centered approach stands in contrast to traditional models that often prioritize a list of diagnoses over the individual's desires. Engaging in these conversations builds trust and empowers the older adult to become a partner in their own care.
To address this M, healthcare providers and families should:
- Initiate conversations: Ask open-ended questions to understand the older adult’s priorities and values. Frame goals using the SMART criteria (Specific, Measurable, Achievable, Relevant, Time-bound).
- Document preferences: Clearly record health goals and care preferences in the medical record for all team members to see.
- Involve family and caregivers: Ensure that care partners are included in discussions, especially if the older adult is unable to state their preferences.
Medication
This M focuses on ensuring that medications are age-friendly and do not interfere with what matters, mentation, or mobility. Many older adults take multiple medications, a condition known as polypharmacy, which increases the risk of side effects, drug interactions, and hospitalizations. The 4Ms framework promotes a careful review of all medications, including prescriptions, over-the-counter drugs, and supplements, with an eye toward deprescribing potentially inappropriate or unnecessary drugs. Tools like the Beers Criteria from the American Geriatrics Society are used to identify medications that may cause harm in older adults.
Effective medication management involves:
- Regular review: Conduct a comprehensive medication review at every health visit to assess necessity and potential side effects.
- Focus on deprescribing: Safely reduce or discontinue high-risk medications that may negatively impact an older adult's health or functioning.
- Educate patients: Provide clear information about each medication's purpose, potential side effects, and why it might be deprescribed.
Mentation
Mentation refers to the assessment and management of mental and mood-related conditions, including dementia, depression, and delirium. These conditions are common in older adults and can significantly impact their quality of life and ability to engage in activities that matter to them. Early identification and appropriate management are key to preventing further decline and improving outcomes. For example, screening for depression can lead to interventions that positively affect both mood and mobility.
Managing mentation includes:
- Routine screening: Use validated screening tools for dementia (e.g., Mini-Cog, MoCA), depression (e.g., PHQ-2, GDS), and delirium (e.g., CAM).
- Comprehensive management: Develop a care plan that addresses the specific needs of the older adult, which may include therapy, medication, and supportive resources.
- Educate caregivers: Inform families and caregivers about the signs and symptoms of mental health issues and how to provide support.
Mobility
Promoting safe and daily movement is the final M, ensuring older adults can maintain function and independence to do what matters to them. Age-related changes like muscle weakness, balance issues, and arthritis can limit mobility, increasing the risk of falls. The 4Ms framework emphasizes interventions that encourage safe physical activity tailored to the individual's abilities and goals.
Enhancing mobility can involve:
- Assessing fall risk: Screen older adults for fall risk using tools like the Timed Up and Go (TUG) test.
- Encourage regular activity: Implement routines that include early, frequent, and safe movement, such as walking or chair exercises.
- Modify the environment: Address safety hazards at home, such as loose rugs and poor lighting, and consider assistive devices like grab bars or walkers.
Comparison of 4Ms Age-Friendly Care vs. Traditional Care
| Feature | 4Ms Age-Friendly Care | Traditional Care |
|---|---|---|
| Focus | Centered on the older adult's goals and priorities | Primarily focused on treating diseases and conditions |
| Medication Management | Emphasizes deprescribing inappropriate meds and minimizing drug burden | Tends to add medications to address new symptoms or conditions |
| Mental Health | Systematically screens for and manages dementia, depression, and delirium | May only address mental health issues when a specific problem is flagged |
| Mobility | Proactively promotes safe, daily movement and fall prevention | Addresses mobility issues reactively, often after a fall or injury |
| Provider-Patient Relationship | Collaborative, with the patient as an empowered partner | Often paternalistic, with the provider making most decisions |
The Intersection of the 4Ms
The four elements of the 4Ms framework are not isolated; they are deeply interconnected. For instance, a medication change (Medication) could affect an older adult's mental clarity (Mentation), which in turn impacts their ability to move safely (Mobility) and participate in activities that are important to them (What Matters). By approaching care holistically, providers can identify and mitigate these cascading effects. For example, deprescribing a sedative that causes confusion (Mentation) can also improve balance (Mobility), helping the older adult achieve their goal of walking daily (What Matters). This integrated perspective is what makes the 4Ms framework so powerful in improving health outcomes and quality of life for seniors.
Conclusion
For older adults, healthcare can often feel complex and overwhelming. The 4Ms framework offers a powerful, evidence-based solution by providing a person-centered and holistic approach to care. By prioritizing what matters most to the individual and systematically addressing medications, mentation, and mobility, this model helps healthcare systems deliver higher-quality, safer, and more satisfying care. Adopting the 4Ms transforms care from a reactive, disease-focused model to a proactive, person-centered one, ultimately enabling older adults to maintain their independence and thrive. Healthcare providers and family caregivers alike can use this framework to ensure that every older adult receives the best care possible. Learn more about the Age-Friendly Health Systems initiative.
